Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort

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dc.contributor.author Carmona, Sergio
dc.contributor.author Bor, Jacob
dc.contributor.author Nattey, Cornelius
dc.contributor.author Maughan-Brown, Brendan
dc.contributor.author Maskew, Mhairi
dc.contributor.author Fox, Matthew P
dc.contributor.author Glencross
dc.contributor.author Ford, Nathan
dc.contributor.author MacLeod, William B
dc.date.accessioned 2018-05-31T09:37:59Z
dc.date.available 2018-05-31T09:37:59Z
dc.date.issued 2018-03
dc.identifier.citation Sergio Carmona, Jacob Bor, Cornelius Nattey, Brendan Maughan-Brown, Mhairi Maskew, Matthew P Fox, Deborah K Glencross, Nathan Ford, William B MacLeod; Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort, Clinical Infectious Diseases, Volume 66, Issue suppl_2, 4 March 2018, Pages S111–S117, https://doi.org/10.1093/cid/ciy045 en_US
dc.identifier.uri https://doi.org/10.1093/cid/ciy045
dc.description.abstract Background The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL) HIV disease. We assessed disease progression at entry to care using nationwide laboratory data. Methods We constructed a national HIV cohort using laboratory records containing HIV RNA loads and CD4 counts from 2004 to 2016 to determine entry into care. We estimated numbers and proportions of adults with the first CD4 count <100 cells/ μL or 100–199 cells/μL. We calculated relative risks of presenting with advanced disease associated with male sex. Results 8.04 million first CD4 results were identified. From 2005 to 2011, the proportion of patients entering into care with CD4 count <200 cells/μL declined from 46.8% to 35.6%. From 2011 onward, the proportion of patients entering ART with advanced HIV disease has remained relatively unchanged. In 2016, we estimated that of 654 868 patients entering care, 32.9% had advanced HIV disease, and 16.8% had very advanced HIV disease. Men were almost twice as likely as women (23.1% vs 12.6% ) to enter care with very advanced HIV disease. Conclusions The proportion of patients presenting with advanced HIV disease in South Africa remains consistently high despite ART scale-up, representing a large and avoidable burden of morbidity. Early HIV diagnosis, rapid linkage to ART and approaches to attract men into early ART initiation should be prioritized. en_US
dc.language.iso en en_US
dc.publisher Clinical Infectious Diseases Journal en_US
dc.subject advanced HIV disease en_US
dc.subject CD4 cell count en_US
dc.subject morbidity en_US
dc.subject mortality en_US
dc.subject South Africa en_US
dc.title Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort en_US
dc.type Article en_US


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